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209 Cards in this Set
- Front
- Back
Epidermis |
The outermost layer of skin that forms the external surface of the skin |
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The epidermis is made up of __________ and is ___________. |
-Stratified squamous epithelium -avascular (no blood supply) |
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Keratinocytes |
Cells that produce keratin |
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Keratinocytes of the stratum corneum are called: |
Squamous cells (because of their flat shape) |
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Keratinocytes of the stratum basale are called: |
Basal cells |
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Where are the majority of melanocytes found? |
In the stratum basale |
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The primary function of a basement membrane is: |
To anchor an epithelial later to the loose connective tissue underneath |
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The basement membrane of the skin acts as a ___________ __________, preventing malignant cells of the epidermis from invading the deeper tissue. |
Mechanical barrier |
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Angiogenesis |
Development of new blood vessels |
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The dermis is the _______ layer of the skin and contains: |
-middle -the accessory organs and appendages of the skin |
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Merkel's disc |
Clear, oval slowly adapting receptor that senses texture, discrimination of shape, and sustained pressure |
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Merkel's disc is located in the: |
Dermis |
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2 categories of skin cancer: |
-Non-melanomas -Melanomas •Arise from melanocytes |
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Which layer of the epidermis are the melanocytes in? |
Stratum basale |
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2 types of non-melanomas: |
-Basal Cell Carcinoma (BCC) -Squamous Cell Carcinoma (SCC) |
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Basal cell carcinoma arise in: |
The stem cells of the stratum basale |
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Squamous cell carcinoma arise in: |
More mature keratinocytes in the upper layers of the epidermis |
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The most common type of non-melanoma is: |
Basal cell carcinoma |
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The most important etiologic factor associated with ALL skin cancers is: |
Exposure to Ultraviolet (UV) light |
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Most dangerous type of ultraviolet light: |
Type A ultraviolet light (UV-A) |
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Type A ultraviolet light is able to penetrate to the: |
Stratum basale |
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Previous superficial/ orthovoltage radiation exposure is an etiologic factor for: |
Non-melanomas |
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Precursor lesions for non-melanomas: |
-Actinic (solar) keratoses -Arsenical keratoses |
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Actinic (solar) keratoses |
Warty lesions or areas of red, scaly patches occurring on sun- exposed skin of face, arms, or hands |
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Arsenical keratoses |
Multiple, hard, corn-like masses on the palms of the hands or soles of feet resulting from long-term arsenic ingestion |
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Thermal or electric burns; chronic heat exposure is an etiologic factor specifically for: |
Squamous cell carcinoma |
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Nevus |
Benign, slightly pigmented cutaneous lesion; commonly known as birthmark or mole |
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Nevus is an etiologic factor for: |
Melanoma |
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Benign nevi tend to: |
• Be symmetrical • Possess clearly defined, smooth borders • Be uniformly tan or brown • Be less then 6mm in diameter (the size of a pencil eraser) |
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70% of melanomas develop as a result of: |
A change in a pre-existing benign nevus |
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De novo melanoma |
Melanomas that do not develop from a pre-existing benign nevus |
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Dysplastic nevus |
A nevus whose appearance is atypical from other nevi |
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These are precursor lesions for melanoma: |
Dysplastic nevi |
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Common clinical presentation of non-melanomas: |
-Any new growth that persist or change in appearance -A wart that bleeds or scabs and becomes itchy or tender -A sore that takes longer than three weeks to heal |
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Specific presentations of basal cell carcinoma: |
-Arise as smooth, red or milky lumps •A few may contain melanin and may appear black -Have a pearly border -Have multiple telangiectasis -May be shiny or pale *Most common site for BCC is head and neck |
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Telangiectasis |
Spider veins |
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Specific presentations of squamous cell carcinoma: |
-Have a scaly, crust, slightly elevated lesion that may have a cutaneous horn -Most common site: Arms |
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Clinical presentation of melanomas: |
-Asymmetrical -Notched uneven borders -Contain different shades of black, brown, or tan -Diameter > 6mm |
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The most common site of occurrence for melanoma in MEN is on the: |
Trunk and face |
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The most common site of occurrence for melanoma in WOMEN is on the: |
Legs |
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"ABCD" rules for early detection of melanomas: |
A-asymmetry B-border C-color D-diameter |
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Detection and Diagnosis •Suspected BCCs |
Shave biopsy or curettage |
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Detection and Diagnosis: •Suspected SCCs or melanomas |
Excisional biopsy |
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Non-melanoma metastasis |
Direct extension |
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BCCs vs. SCCs |
BCC- extremely slow growing SCC- faster growing, more aggressive, and have a higher risk of metastasis then BCC |
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What has the highest risk of metastasis of all skin cancers? |
Melanomas |
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Melanoma metastasis |
-Direct extension (most common) *If they do metastasize via blood, they go to the LUNG |
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Melanomas may be "microstaged" using 2 systems, which are critically important prognostic indicators. They are: |
1. Clark's level 2. Breslow's depth |
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Clark's level |
Categorizes melanomas based on their level of invasion through the epidermis and layers of the dermis |
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Breslow's depth |
Categorizes melanomas based on tumor thickness *More accurate indicator of the metastatic risk and prognosis than the Clark's level |
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Most common histologic type of basal cell carcinoma |
Nodular BCC |
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Nodular BCC appearance |
Smooth, shiny and translucent accompanied by telangiectasis |
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Rodent Ulcer |
-Type of BCC :Large nodular lesion with central necrosis |
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The two most common histologic types of SCC are: |
Bowen's disease Keratoacanthoma |
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Bowen's disease |
Considered SCC in situ; characterized by pink or brown papules covered with a thickened, horny layer |
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Keratoacanthoma |
Considered a well-differentiated, *low grade SCC*, characterized by a rapid-growing lesion that can appear suddenly as a *dome-shaped mass* on a sun-exposed area |
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Most common histologic type of melanoma |
Superficial Spreading Melanoma (SSM) |
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Superficial Spreading Melanoma frequently arises from: |
A precursor lesion (previously benign) |
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Most aggressive form of melanoma |
Nodular Melanoma |
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Treatment of choice for small non-melanomas |
Surgery |
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Treatment of choice for melanomas |
Surgery |
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Melanomas are considered __________, but __________ with high doses per fraction. |
-radioresistant -radioresponsive |
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Hypofractionated EBRT for Melanomas |
High dose (6000cGy) delivered twice per week for 5 fractions
*increase in daily dose, decrease in protraction (# of fractions) |
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Mycosis Fungoides |
A type of Non-Hodgkin's Lymphoma that affects the skin *AKA: cutaneous T-cell lymphoma |
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Treatment for Mycosis Fungoides |
Total skin electron therapy (TSET) |
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Kaposi's Sarcoma most common presenting symptoms: |
Nodules or blotches that may be red, purple, brown, or black, and are usually palpable or raised |
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Kaposi's Sarcoma metastasis |
Hematogenous |
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Kaposi's Sarcoma is radio______, but not ______. |
-Sensitive -Curable |
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What type of tumor is Merkel's Cell Carcinoma? |
Neuroendocrine
*Associated with a virus |
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Merkel's Cell carcinoma develops where? |
In Merkel cells, just beneath the skin and in hair follicles |
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Merkel's Cell Carcinoma metastasis |
Lymphogenous
*not curable |
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Treatment of choice for Merkel's Cell Carcinoma |
Surgery |
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Keloids |
A type of scar which results from an overgrowth of collagen at the site of a healed skin injury or wound |
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Keloids appearance |
-Firm, rubbery lesions or shiny, fibrous nodules -Can vary from pink to flesh-colored or red to dark brown - May be itchy or tender to the touch |
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Keloids in females occur most commonly in the: |
Earlobes (due to piercing) |
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Keloids in males occur most commonly on: |
The face (due to shaving injury) |
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Keloids are most common in dark-pigmented individuals. |
15 times higher risk in persons of African descent |
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Hematopoiesis |
The process of formation and development of the various types of blood cells |
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Where does Hematopoiesis occur? |
Red bone marrow |
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Ossification |
The process by which hyaline cartilage and connective tissue membranes are replaced by bone |
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Osteoblasts |
Immature bone-forming cells that produce hormones and alkaline phosphate which assist with bone formation |
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Alkaline phosphate |
An enzyme that helps mineralize bone |
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Epiphyseal plate |
A flat plate of hyaline cartilage responsible for the lengthwise growth of long bones in children |
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Primary site of ossification |
Middle of the diaphysis |
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Osteoclasts |
Phagocytic bone cells that assist with absorption and removal of bone; release calcium into the blood |
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Malignant tumors that arise from the mesenchyme are referred to as: |
Sarcomas |
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The two most common sites of occurrence of primary bone cancer are in the: |
-Distal femur -Proximal tibia |
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Ischemia |
Absent of blood, oxygen, nutrient supply |
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2 basic types of osseous tissue: |
-Compact -Spongy |
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Iatrogenic |
Cancers that are the result of medical treatment; induced by the treatment itself |
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Iatrogenic cancers are most commonly associated with: |
-Previous external beam irradiation -Internal bone-seeking radionuclides from medical occupational exposures and medical procedures |
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The most common presenting symptom of most bone cancers/tumors is: |
Pain in the area of the tumor |
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Bone cancers associated with a pathological fracture |
-Metastatic bone cancer -Multiple Myeloma |
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What is the most important diagnostic tool prior to biopsy in bone cancer? |
Conventional radiographs |
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Bone cancers/tumors may be lytic or blastic. What is lytic? |
To break-up, disintegrate or destroy bone |
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Bone cancers/tumors may be lytic or blastic. What is blastic? |
To build-up, form or produce bone |
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This appearance implies *aggressive* cancer/tumor with bone invasion: |
Moth-eaten or punched-out appearance *Associated with: Metastatic bone cancer and Multiple Myeloma |
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Ewing's Sarcoma radiographic appearance: |
"Onion" pattern |
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Elevated Prostate Specific Antigen (PSA) can indicate: |
Metastatic bone cancer |
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Epiphyses |
The ends of long bones that consists of spongy bones sandwiched between a thin layer of compact bone |
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A blood chemistry study showing elevated alkaline phosphatase (ALP) can indicate: |
-Metastatic bone cancer -Osteosarcoma |
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Biopsy techniques for bone cancers/tumors may include: |
Incisional biopsy (most common) |
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The 2 staging systems specifically for Multiple Myeloma: |
-Durie-Salmon -International Staging System (ISS) for Multiple Myeloma |
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The most common route of metastasis for primary bone cancer is: |
Hematogenous |
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Skip metastasis |
A second site of metastasis that is smaller than the first and is located in the same bone or in a bone on the opposing side of a joint space (i.e. Femur and tibia) *usually means cancer is in the medullary cavity |
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Treatment of choice of most primary bone tumors: |
Surgery |
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Diaphysis |
The long shaft of the bone |
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Metaphysis |
The widest portion of the diaphysis that is adjacent to the epiphysis |
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Epiphyseal line |
A thin line of bony tissue between the Epiphyses and diaphysis that is noticeably different from surrounding bone *Is a remnant of what used to be the epiphyseal plate or "growth plate" in children *Epiphyseal plates are located in the metaphysis region |
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Medullary cavity |
The cavity found within the shaft of the bones |
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Osteocyte |
Mature bone-forming cells |
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Two types of bone marrow: |
Yellow Red |
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Treatment of choice of most primary bone tumors: |
Surgery |
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Limb salvage surgery |
Wide en bloc resection; only take out what you need |
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Symptoms of malignant spinal cord compression: |
-Relentless and progressive back pain -Paralysis (partial or total) -Sensory loss -Urinary and fecal incontinence |
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Goal of treatment for metastatic bone cancers: |
Palliation |
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Most common radioisotope used to treat metastatic bone cancers: |
Strontium 89 (T1/2 is 50.5 days or 1212 hours |
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Most common type of primary bone cancer: |
Osteosarcoma |
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Osteosarcomas arise from: |
Osteoblasts |
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Most common histology of primary bone tumors in adolescents: |
Osteosarcoma |
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Osteosarcoma most often develops in the: |
-Metaphysis- children -Diaphysis- adults |
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Most common site of occurrence for osteosarcoma is: |
The knee joint |
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98% of Osteosarcomas metastasize to the: |
Lung |
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Most common histopathology of a radiation induced bone sarcoma is: |
Osteosarcoma |
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Cyclophosphamide |
Cystotoxicity: hemorrhagic cystitis |
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Osteosarcomas are chemo_______ and radio_________. |
-sensitive -resistant
(Usually do chemo and surgery) |
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2nd most common type of primary bone cancer in adults: |
Chondrosarcoma |
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Chondrosarcoma develops most often in the: |
Epiphyses |
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The most common site of occurrence for chondrosarcoma is in the: |
Pelvis |
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Chondrosarcomas are chemo_________ and radio________. |
-resistant -resistant |
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A chondrosarcoma has a ________ prognosis than an osteosarcoma. |
Better |
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Most common histology of Fibrosarcoma is: |
Malignant Fibrous Histiocytoma (MFH) |
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Most common site of occurrence for both Fibrosarcoma and MFH is the: |
Femur |
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2nd most common primary bone cancer in children is: |
Ewing's Sarcoma |
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Ewing's sarcoma develops most often in the: |
Diaphysis |
|
Methotrexate |
Gastrointestinal toxicity: stomatitis and mucositis |
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Most common site of occurrence for Ewing's Sarcoma is the: |
Lower extremities |
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Ewing's sarcomas have a unique microscopic appearance. They are composed of cells with: |
Hyperchromatic bluish nuclei and very little cytoplasm that are arrayed in sheets |
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Malignant Spinal Cord Compression is commonly associated with: |
Ewing's sarcoma |
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Ewing's sarcoma are very chemo_________ and radio________. |
-sensitive -sensitive |
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Giant Cell Tumors of the bone (GCTB) has both: |
Benign and malignant forms |
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Giant cell tumors of the bone develops most often in the: |
Metaphysis and epiphyses |
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Most common site of occurrence for GCTB is the: |
Knee joints |
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Multiple Myeloma is not a bone tumor. It is classified as a: |
B-cell lymphoma that is capable of forming tumors in the bone |
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Multiple myeloma arises from _______ ___ that are produced in the bone marrow and transported through the ____________ __________. |
-plasma cells -lymphatic system |
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Multiple Myeloma is the most common lymphoreticular tumor in: |
Non-Caucasians |
|
Adriamycin |
Cardiotoxicity: cardiac failure |
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Multiple myeloma has an increased incidence in: |
-survivors of atomic bomb in Hiroshima and Nagasaki -African Americans -First degree relatives (FDR) |
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Multiple Myeloma increases the activity of: |
Osteoclasts |
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Multiple myeloma's most common site of occurrence is the: |
Skull |
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Multiple myeloma is also commonly associated with: |
Malignant spinal cord compression (MSCC) |
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Goal of treatment for multiple myeloma is: |
Palliation |
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Multiple myeloma is chemo_______ and radio_________. |
-sensitive -sensitive
No surgery-too wide spread |
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Benign bone tumor: Heterotopic Bone Formation- |
A benign condition associated with abnormal bone formation outside the skeleton (specifically in the muscle) AKA: Hypertropic ossification (HO) |
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The most common place for Hypertropic bone formation is in the: |
Hip |
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Benign bone tumors typically occur as: |
Bumps on the external surface of the periosteum or inside the medullary cavity |
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Common side effects of radiation therapy for bone cancers: |
-Lymphedema -Pathological fracture -Increased risk of bone infections -Avascular necrosis |
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Vincristine |
Neurotoxicity: peripheral neuropathy |
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Radiation therapy side effects from treating bone cancer in children: |
-Bone shortening/stunted growth -Slipped capital femoral epiphysis -Iatrogenic or "second" malignancies |
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Slipped capitols femoral epiphysis- |
A fracture through the epiphyseal "growth" plate of the proximal femur that results in the slippage of the overlying epiphysis |
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Cisplatin |
Nephrotoxicity: renal failure |
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Primary bone tumors are relatively radio______: |
resistant |
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Radiosensitive bone cancers |
-Metastatic bone tumors -Ewing's sarcoma |
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Most common site of metastatic bone cancer: |
Vertebrae -pedicle |
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Primary tumors that have a propensity to metastasize to the bone: |
Men- Prostate cancer Women- Breast cancer |
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Soft tissue sarcoma: Malignant Fibrous Histiocytoma (MFH)- |
Mixed tissues |
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Soft tissue is ____ encapsulated. |
Not |
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Most common site of occurrence of soft tissue sarcoma in the extremities is |
Proximal posterior portion of the thigh and buttocks |
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Angiosarcoma may develop as a result of Stewart-Treves Syndrome- |
A condition associated with chronic lymphedema |
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Most common presenting symptom of soft tissue cancer: |
Painless mass or swelling |
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Parenthesis- |
An abnormal sensation, such as burning, pricking, tickling, or tingling |
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Constitutional symptom of heat in the tumor- |
Calor |
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Most common route of metastasis in soft tissue sarcomas- |
Direct extension- •fingerlike projections extend through and beyond the pseudocapsule and may form "satellite" tumors independent from the primary mass |
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Most common site of hematogenous metastasis in soft tissue cancer is- |
Lungs |
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The most important prognostic factor for soft tissue sarcomas: |
Grade |
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Treatment of choice for most soft tissue sarcomas: |
Surgery |
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Most common histologic subtype of soft tissue sarcoma in adults: |
Malignant Fibrous Histiocytoma |
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Soft tissue cancer surgery: if used with adjuvant radiation therapy, the surgical incision should be placed: |
Laterally -the surgeon should identify the tumor bed and suspected margins with radiopaque surgical clips in case post-op radiation therapy is required |
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Soft tissue cancer: Rhabdomyosarcomas are the most- |
Chemosensitive |
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Soft tissue cancers are considered highly radio_______ |
Resistant |
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Soft tissue cancer: Liposarcomas are the most |
Radiosensitive |
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Limb salvage techniques include: Sparing a strip of soft tissue on the medial aspect of the extremity treatment field from irradiation to preserve: |
Lymphatic drainage |
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Intraoperative Radiation Therapy (IORT) |
A technique the involved irradiation of the tumor during a surgical procedure |
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Radiation therapy is used most often in soft tissue cancers for |
Retroperitoneal and pelvic sarcomas |
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The most common site of local recurrence in soft tissue cancer: |
Pseudocapsule |
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Most common benign soft tissue tumor of the uterus- |
Leiomyoma |
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Most common benign soft tissue tumor: |
Lipoma |
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Soft tissue sarcoma: Liposarcoma- |
Adipose (fat) tissue |
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Second most common histology subtype of soft tissue sarcoma in adults: |
Liposarcoma |
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Most common soft tissue sarcoma of the retroperitoneum: |
Liposarcoma |
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Intraoperative Radiation Therapy (IORT) |
A technique that involves irradiation of the tumor during a surgical procedure |
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Soft tissue sarcoma: Rhabdomyosarcoma- |
Striated muscle tissue, these muscles are voluntary |
|
Malignant Schwannoma- |
Peripheral nerve sheath tissues |
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Malignant Schwannoma is also know as- |
Neurofibrosarcoma |
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As soft tissue sarcomas grow, they form a zone of reactive tissue called a "pseudocapsule"- |
A false capsule around the muscle compartment that is composed of compressed tumor cells and fibrotic tissue |
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The 2 most effective chemotherapy drugs for soft tissue sarcomas are: |
Ifosfamide Doxorubicin |
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Ifosfamide chemotoxicity: |
Hemorrhagic cystitis toxicity |
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Dioxyrubicin (Adriamycin) chemotoxicity: |
Cardiomyopathy toxicity |
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Vincristine chemotoxicity: |
Neuropathy toxicity |
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Cyclophosphamide chemotoxicity: |
Hemorrhagic cystitis toxicity |
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Bleomycin chemotoxicity: |
Pulmonary toxicity |
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Type of cancer most commonly linked to precursor lesions- |
Squamous cell carcinoma |
|
Skin cancer: epidemiology |
-Light skinned people who tend to tan poorly and sunburn easily -More common in those who live near the equator -More common in those who live at high altitudes -Higher risk of recurrence or 2nd primary in persons with a prior skin cancer |
|
Skeletal survey |
Used to diagnose Multiple Myeloma |
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Chondrosarcoma grade: |
Low grade |
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Fibrosarcoma and MFH grade: |
High grade |
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Giant cell tumors grade: |
Low grade |
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What kind of surgery is used for Giant Cell Tumors? |
Curettage surgery |
|
Most common site of occurrence for BCC |
Head and neck |